Kerry Toneguzzi has tried everything to lose weight.
From low-calorie and liquid diets to Weight Watchers, nothing worked. In 2007, she had bariatric surgery and lost 100 pounds – only to gain it all back.
When she was diagnosed with diabetes in the fall of 2020, her doctor suggested she try Ozempic – a drug approved in Canada to treat diabetes, with a frequent side effect of weight loss.
“In the beginning, I didn’t think it would ever work for me because nothing really had worked for me,” Toneguzzi, 55, said.
But it did. The Ottawa-area insurance underwriter lost 115 pounds over about two years. What she finds even more remarkable is that she hasn’t gained any of it back.
“For me to maintain my weight for a year, it’s a win,” she said. “This drug has given me a second chance at life.”
Like Toneguzzi, many Canadian obesity specialists and endocrinologists are welcoming Ozempic as a drug that actually works in treating what they say is a genetic, medical condition.
“We’ve failed to have success in pharmacotherapy until now,” said Dr. Sean Wharton, an internal medicine specialist who runs a weight and diabetes management clinic in Burlington, Ont.
With the advent of Ozempic, people living with obesity finally have a drug that can make a difference and can be an alternative to bariatric surgery, he said.
But Ozempic has gained notoriety in recent months, with celebrities singing the drug’s praises and many people posting success stories in weight loss they attribute to the drug.
Demand for Ozempic in Canada has risen steadily over the last year, according to the Neighbourhood Pharmacy Association of Canada, which represents most of the major pharmacy chains in Canada, as well as many community drugstores.
The problem with that, some doctors and pharmacists say, is that Ozempic isn’t intended for patients who want to drop a few pounds of “cosmetic weight.” Plus, people who need Ozempic likely need it for life – studies have shown that once they stop taking it, the weight often comes back.
“(There) should be no question about that. Nobody should think that they’re using this for short term and going to stop it,” Wharton said.
“This is a forever medication because (obesity is) a genetic disease.”
Ozempic costs between $200 and $300 per month in Canada. Its manufacturer, Novo Nordisk, also got Health Canada approval in 2021 for a drug called Wegovy. Ozempic and Wegovy have the identical active ingredient – semaglutide – but Wegovy is a higher dose to specifically treat obesity.
Health Canada has also approved Wegovy for people who are overweight and also suffering from a serious weight-related condition such as hypertension, diabetes or obstructive sleep apnea.
Semaglutide works by acting like a hormone called glucagon-like peptide-1 (GLP-1), which promotes insulin production and also stimulates part of the brain that controls appetite. Patients take it by injection once a week.
Because Wegovy is not yet available in Canada – and Novo Nordisk has not given a date when it will be – some doctors are prescribing Ozempic at higher doses for their patients suffering from obesity.
Dr. Ehud Ur, an endocrinologist at St. Paul’s Hospital and Vancouver General Hospital, said it’s important to look at Ozempic and Wegovy as a medical solution to treat a life-threatening medical condition, in conjunction with changes to diet, exercise and sleep habits.
“Most people don’t understand that obesity is not a cosmetic problem. It’s a significant disease. People with obesity will have a 10, 15, 20-year reduction in their life expectancy because of their weight problems,” said Ur.
But on the front lines of primary care, family doctors have been fielding a growing number of pleas from patients who want an Ozempic prescription, even though they’re not suffering from obesity, said Dr. Iris Gorfinkel, a family physician in Toronto.
“People who are coming to me as a family doctor … are people who, you know, they’re struggling with the belly fat, they’re not even diabetic, they’re not even pre-diabetic and they’re asking for the drug,” she said.
Shelita Dattani, vice-president of pharmacy affairs for the Neighbourhood Pharmacy Association of Canada, also practices on a family health team that is dealing with patients looking for Ozempic as a “quick fix” for weight loss.
“I’ve had people ask me, I’ve had friends ask me … ‘you know, I have a wedding coming up’ or ‘I need to be in a bikini’ or whatever it is,” Dattani said.
Gorfinkel and Dattani both say those requests require thoughtful conversations with patients about weight loss and other measures they can take.
“Obesity is a holistic problem. It is a biopsychosocial problem,” Gorfinkel said.
Those conversations take a lot longer than just saying yes and writing a prescription, she said.
Gorfinkel also worries about potential side effects.
According to Novo Nordisk’s Ozempic information website, the most common side effects include nausea, vomiting, diarrhea, constipation and abdominal pain.
Those symptoms go away after a few weeks, said Ur.
The website also lists more serious potential side effects including inflammation of the pancreas, gallbladder problems, kidney problems and low blood sugar.
It also notes that studies in rats showed thyroid tumours. Both Ur and Wharton said there’s no reason to believe that would happen in humans.
The health risks of living with obesity often outweigh the potential risks of taking the drug, they said.
“It’s important to understand who are the appropriate patients to treat because not everyone is a candidate for Ozempic,” Ur said.
“The simple point to make is that in any treatment in medicine you’re balancing risk against benefit.”
Gorfinkel said she would consider prescribing Ozempic along with lifestyle changes if the patient met the medical criteria for obesity.
But so far, that hasn’t happened.
“I have yet to prescribe it to any patients,” Gorfinkel said.
“I’m extremely skeptical. I worry tremendously that if I do prescribe it what may happen is that when they come off of it, they may experience significant weight gain.”
When asked if Ozempic and Wegovy are meant to be taken for the rest of patients’ lives, Novo Nordisk Canada said in an email, “Just like other chronic diseases, type 2 diabetes and obesity both require long-term management.”
“Decisions about the appropriateness and duration of any medication should be made on an individual basis in consultation with a health-care professional,” spokeswoman Amy Snow said.
Toneguzzi, who has started a Facebook group in Ottawa for others who are considering Ozempic, has no illusions that the drug is anything short of a lifelong commitment to help maintain her weight.
She also wants to help others be realistic in their expectations, noting that along with taking Ozempic, she worked hard on her weight loss, including a “very regimented” approach to her diet.
“It’s not a miracle,” she said.
“It wasn’t just the medication. I had to change my complete lifestyle.”
This report by The Canadian Press was first published March 8, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
